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Managing Anxiety: The Basics
Rachel Hagerty, MA, Limited License Psychologist
Rochester Hills, Michigan
[We’re welcoming our local friend and Psychologist, Rachel Hagerty, as our guest blogger on Managing Anxiety, a common condition affecting many of us at some point in our lives. Rachel will share some useful, self-motivated techniques in managing the symptoms of anxiety. We’ll be sharing these techniques in a 2-part series. Take it away, Rachel!]
In our lives we experience a multitude of events; some thrilling, others difficult, life altering and ordinary. From navigation through life changes, to finding balance between our home and personal life, or maintaining our sense of self while fulfilling many other roles our daily lives can be very challenging and demanding. So if you are finding yourself burning the candle at both ends and feeling like you’re being pulled in too many directions at once, believe me when I say you’re not alone.
According to the National Institute of Mental Health website, anxiety disorders effect 18.1% of the adult US population with the average age of onset at 11 years old.
Consistently dealing with large amount of stress can lead to symptoms of anxiety that could possibly lead to depression-like feelings as well. It’s a rather slippery slope; one that many people tend to find themselves facing.
You’ve probably heard about the Zika virus in the news, and hopefully you know of the CDC recommended travel warning for pregnant women, or those women trying to become pregnant; avoid non-essential travel to areas with the Zika virus.
The Zika virus has been associated with the development of a birth defect called microcephaly, as well as miscarriage. Microcephaly is a condition of small head and brain development, and can be associated with seizures, eye abnormalities, hearing loss, and other problems in growth and neurologic development.
Whether teenagers discuss it with their parents or not, they are likely to feel some aspect of social pressure regarding the initiation of sexual activity. In counseling our teenage girls, I try to get them to assess their own attitudes regarding their readiness for sexual activity, as well as their understanding of the potential consequences of engaging in sex, like risks for stds, pregnancy and social stigmata.
I love giving them my “It’s your Choice” talk, encouraging them on the option of abstinence, or waiting on sex. I want them to understand that the decision to engage in sex, is just one of the many decisions they’ll have to make for themselves, and that making a ‘good decision’, means understanding the risks of the behavior.
Nausea in pregnancy is very common, affecting more than 50% of pregnant women. Though commonly called ‘Morning Sickness’, the symptoms can occur at any time of the day. Nausea of pregnancy usually improves by 14-16 weeks, but can continue throughout the pregnancy for some women. Nausea in pregnancy is usually not harmful to your developing baby, but may become more problematic when associated with consistent vomiting and weight loss.
The cause of Nausea in Pregnancy is not well understood. It may be caused by the elevated hormone levels of pregnancy and their effect on slowing overall gut motility. The GI tract is normally constantly moving food and stomach acid from the stomach, though the GI tract. The effect of slower gut motility can result in a feeling a nausea after eating a large (your standard sized) meal, where food isn’t moving out of the stomach at the same rate. With slower gut motility, stomach acids aren’t moving out of the area at a normal rate either, potentially also causing a feeling nausea when we go 3-4 hours without eating.
Dense breast tissue is an independent risk factor for breast cancer, both increasing our risk of breast cancer and decreasing the sensitivity of mammography to detect breast cancer. Increased breast density, as identified by mammography, can negatively impact the ability of mammography to detect breast cancer. Further, women with dense breast tissue have a 3-5 fold increased risk for breast cancer, over those without significant breast density.
“My husband wants me to discuss my lack of interest in sex”… As Gynecologists, this is a patient concern not unfamiliar to us. Has low sexual desire been a concern for you in your relationship? Would you ever consider the use of a medication for its improvement? Well I’d hope that most of my patients would want to first examine the possible reasons for low libido, even if their answer is ‘yes’ to trying a medication for it.
But herein lies the concern. Defining the sources of low libido in women is not easy. Research tells us that nearly 4 in 10 women experience some degree of female sexual distress at some point in our lives. The definition of Female Hypoactive Sexual Disorder is made by conditions characterized by loss of sexual desire, impaired arousal, difficulty in achieving orgasm, or sexual pain, with low desire and sexual pain being the most common.
The stages of female sexual arousal have been well studied, and fairly well defined, since the 1960’s with research done by Masters and Johnson. However, the components of female sexual desire remain complex. Sexual desire in women is likely a multi-factor phenomenon, involving biologic, psychologic and social factors, which can elude clear delineation.
When considering a woman’s contraceptive options, IUDs bear discussion. Some women have familiarity with IUD use, others have “heard of them”, but don’t have a real concept of how they’re used or how they work. An IUD (Intra-Uterine-Device) is a contraceptive device placed inside the uterus, in an in-office procedure, that generally takes less than 5 minutes for your doctor to insert. Pregnancy prevention occurs by a ‘foreign body’ inflammatory reaction that occurs based on the metal or plastic frame (T-shaped, about the size of an open paperclip) and by the local effect of the medication released by the IUD (either copper or progesterone.) This ‘inflammatory reaction’ likely creates a toxic environment for sperm (spermicidal), as well, likely inhibits implantation.
Have you heard the theory that antibiotic use can lessen the effectiveness of your birth control pill? Though there is some truth to this theory, it’s fortunately NOT true for most commonly prescribed antibiotics.
Pharmacologic studies evaluating hormonal levels during antibiotic use have shown decreased hormonal levels (leading in theory to potential decreased effectiveness) with only one type of antibiotic, Rifampin (an anti-tuberculosis medication) whose use is fairly uncommon. Women taking this particular antibiotic should not rely on their hormonal birth control (OCP, DepoProvera, or implant) solely for contraception during its use. Use of a non-hormonal form of back-up birth control is recommended in these women.
Other antibiotics have NOT been proven to affect the pharmacologic levels of hormonal contraception. Some of the more commonly used antibiotics, metronidazole, ampicillin, tetracycline, doxycycline, ciprofloxacin, or diflucan have not shown to decrease oral contraceptive levels in pharmacologic studies.
For women taking antibiotics (other than Rifampin) with birth control pills, back-up contraception is therefore, not required.
If you are sick, requiring antibiotic use or not, considerations for decreased effectiveness of your birth control pill may be due to missed pills, or due to vomiting, in which case back-up birth control would be recommended.
The flu season is definitely among us, with January being the peak season for influenza outbreaks. The CDC has predicted a more severe 2014-2015 flu season this year, with 91% of influenza infections thus far being due to the H3N2 virus. Unfortunately, because of the guesswork involved in manufacturer’s development of the upcoming year’s vaccine strains, this year’s flu vaccine has only a 48% match to the H3N2 viral strain. Nonetheless, flu illness does appear to be less severe in those having received the vaccine. Of particularly grave significance, is the prevention of the flu in pregnant women. Pregnancy infers particularly high risks for the development of severe illness in mothers to be. Pregnancy related changes in our immune systems make pregnant women at higher risk for developing severe complications of the flu, such as pneumonia, respiratory distress and even death. In the 2009 pandemic of the H1N1 influenza virus, 5% of deaths occurred in pregnant women, though pregnant women accounted for only 1% of the U.S. population. The CDC and ACOG strongly advise pregnant women to receive the flu vaccine, noting its safety in all trimesters of pregnancy.
If you’re pregnant, be sure to get your flu vaccine. The most common symptoms of the flu are fever, cough, nasal congestion, sore throat, headache, shortness of breath and muscle aches. Be sure to contact your health care provider if you’re experiencing any symptoms of the flu.
Suzanne Hall, MD Ob/Gyn (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Macomb, Roseville, Grosse Pointe, Rochester, MI
The truth is, we’re all at different stages of our lives as women. Several of my friends, sisters, and I are at this very interesting time in our lives, the menopausal transition, and yes, just beginning to meet, “Ms. PeriMenopause” for the first time ourselves. Our 40-50 yo ‘girl-talk’ usually ends up with some discussion around the topics of hot flashes, or how much more difficult it is now to lose weight.
But what’s less often spoken of amongst my friends, are the symptoms of mood swings and irritability, which can also be symptoms of the peri-menopausal transition. Have you seen yourself go from ‘zero-sixty’ in irritability (or anger), or get easily tearful over things that you know before wouldn’t have upset you so easily? Well I certainly have. Hopefully this bit of information will help you to understand some of the hormonal and emotional shifts that can occur in the perimenopause, giving us some control over that feeling of our ‘raging’ hormones...
In a recent ruling from the Hobby Lobby case, The Supreme Court has ruled that ‘for-profit’ businesses can now evoke the religious rights disclaimer regarding contraceptive coverage. This means that non-religious business can now forgo the previous ACA mandates requiring contraceptive (no co-pay) coverage for women, an exception previously afforded only to religious based business with objection to this mandate for religious reasons. According to a recent article in Medscape.com, “The Court ruled 5-4 that closely held corporations, or companies with a small group of shareholders, may refuse to cover methods of contraception that they oppose for religious reasons.”
In the last few years, the guidelines on the required frequency of cervical cancer screening (Pap smear) have changed, and more recently, even the importance of your Yearly/Annual Pelvic exam has been up for debate amongst established medical societies. The American College of Obstetricians and Gynecologists, ACOG, recently released their rebuttal statement, reconfirming their support for the importance of the Annual Pelvic Exam. Their statement was made in response to the recently released article from the American College of Physicians supporting the contrary, recommending against the annual pelvic exam in asymptomatic women, thus bringing into question the utility of the exam.
‘Tis the season for high school graduations, and thus that (sometimes dreaded) question for graduates, "What are you gonna do?" Though college bound, I can still remember that question being pretty awkward for me, because I had no real clue of what my career interests/aspirations were. I found that a simplistic answer, like “business”, seemed to satisfy most of those that asked, though I barely even had a clue of what a focus in “business” really meant. If not for a great career counselor at my university helping to identifying my strengths in math/science, and directing me towards potential careers stemming from those interests…you wouldn’t know me as Dr. Hall!
In the process of labor your baby’s normal fetal heart rate patterns assure us of the well-being of the baby, and it’s tolerance of the process of labor. During labor, the baby’s heart rate is monitored most commonly by a device called the Electronic Fetal Monitor. Many of you may be familiar with the device with the 2 Velcro straps wrapped across your belly. One of the circular sensors of the monitor laid across your abdomen picks up the fetal heart rate, while the other sensor measures the frequency of your contractions.
While we don’t intend for labor to be a ‘stressful’ condition for you or your baby, the reality is that the arduous process of labor can be a stress to both of you. While in labor, we monitor our Moms with vital signs, oxygen status, often IV hydration, and pain management when requested. Monitoring of the baby’s status during labor happens by our interpretation of the baby’s fetal heart rate patterns, using the Electronic Fetal Monitor. The monitor uses Doppler ultrasound wave forms (no radiation exposure) to record the fetal heart rate pattern, and is considered completely safe, posing no risk to your baby.
Insurance changes, high deductibles, and faulty marketplace applicability are just a few of the burdensome changes invoked as a result of the ACA. Despite the many changes we’re sure to see in our insurance plans, keep in mind that many of the currently available preventive health screenings not only will continue to be available, but importantly, will be covered at no cost to you (no deductible and no co-pay,) by the ACA mandates. Annual Pap smear screenings, mammograms, contraception, and vaccinations will be covered by most insurance plans as a “No-fee Preventative benefit”, even if you participate in a high deductible plan.
Whether you find yourself needing to purchase insurance on the marketplace, or not, it’s possible that you may find changes in your current insurance coverage, such as the institution of higher deductibles. Studies show that participants of high deductible plans are less likely to utilize health services, even those services that are covered at ‘no cost’.
In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
Have you avoided having a mammogram due to fear of ‘pain’ from the testing? This question came up on a recent vacation, while chatting with some of my (non-medical) girlfriends. They related knowing women who’ve avoided having a mammogram because of concerns of the mammogram being too painful. They suggested I write a post about it.
Having ordered many mammograms for women over the years (and having experienced a few myself), though the occasional woman may relate ‘pain’ with the mammogram, most women do not describe the test as “painful”. Uncomfortable and scary…yes. But then again, pain is a subjective matter. In a recent study polling 200 women on their level of pain with a mammogram, 72% rated the “pain” as that equal to a ‘tight fitting shoe’, or a ‘mild headache’. Which of us hasn’t pushed on through their day with a tight fitting shoe, or a mild headache?
Our breasts tend to be more full and tender the week before our menstrual period. If you’re concerned about pain with the mammogram, I’d suggest scheduling the test just after your menstrual period, and not the week or so before your period. Caffeine can cause breast pain as well, so avoiding caffeinated beverages the week or so before the mammogram may also help. An over-the-counter pain reliever taken prior to the mammogram is an option as well.
Apprehension about having a mammogram is understandable. Our breast on a metal plate, with a second plate coming down to compress it…is scary. But, in my opinion, not scarier than the possibility of a missed diagnosis of breast cancer.
Speak with your healthcare provider about scheduling your mammogram, as well as ways to make the testing more comfortable.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Offices in Roseville, Grosse Pointe, Macomb, Rochester, MI